We have a detailed hx. ROS is glycemic control, Allergies. So Hx is Detailed. I think we were seeing the consult and the med management and going for a moderate MDM.
On the EKG, do I need to have the physician say "interpreted by me?" or use the word interpreted in his notes?
I have a partial EKG which I don't if it is a 12 or 3 lead? This strip is only as wide as a notebook piece of paper. It is does say Internal Medicine at the top of the sheet; the doc wrote "EKG Normal" on the partial strip and signed it.
I do have sufficient input from on the Chest part of the Exam, that could be an interpretation.
Here is the question. I don't have a full strip. The doctor did not say "Interpreted by" somewhere in the notes or on the strip; and I don't know if it is 12 or 3 lead.
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